Journal Article Annotations
2024, 1st Quarter

Catatonia

Annotations by Samuel Kohrman, MD
January, 2024

Functional neuroimaging in patients with catatonia: A systematic review.
Exploring seasonality in catatonia diagnosis: Evidence from a large-scale population study.

PUBLICATION #1 — Catatonia

Functional neuroimaging in patients with catatonia: A systematic review.

Laura Duque, Mohammad Ghafouri, Nicolas A Nunez, Juan Pablo Ospina, Kemuel L Philbrick, John D Port, Rodolfo Savica, Larry J Prokop, Teresa A Rummans, Balwinder Singh.

Abstract: J Psychosom Res. 2024 Apr:179:111640. doi: 10.1016/j.jpsychores.2024.111640. Epub 2024 Mar 11.

Background:
Catatonia is a challenging and heterogeneous neuropsychiatric syndrome of motor, affective and behavioral dysregulation which has been associated with multiple disorders such as structural brain lesions, systemic diseases, and psychiatric disorders. This systematic review summarized and compared functional neuroimaging abnormalities in catatonia associated with psychiatric and medical conditions.

Methods:
Using PRISMA methods, we completed a systematic review of 6 databases from inception to February 7th, 2024 of patients with catatonia that had functional neuroimaging performed.

Results:
A total of 309 studies were identified through the systematic search and 62 met the criteria for full-text review. A total of 15 studies reported patients with catatonia associated with a psychiatric disorder (n = 241) and one study reported catatonia associated with another medical condition, involving patients with N-methyl-d-aspartate receptor antibody encephalitis (n = 23). Findings varied across disorders, with hyperactivity observed in areas like the prefrontal cortex (PFC), the supplementary motor area (SMA) and the ventral pre-motor cortex in acute catatonia associated to a psychiatric disorder, hypoactivity in PFC, the parietal cortex, and the SMA in catatonia associated to a medical condition, and mixed metabolic activity in the study on catatonia linked to a medical condition.

Conclusion:
Findings support the theory of dysfunction in cortico-striatal-thalamic, cortico-cerebellar, anterior cingulate-medial orbitofrontal, and lateral orbitofrontal networks in catatonia. However, the majority of the literature focuses on schizophrenia spectrum disorders, leaving the pathophysiologic characteristics of catatonia in other disorders less understood. This review highlights the need for further research to elucidate the pathophysiology of catatonia across various disorders.

Keywords:
Catatonia; Functional neuroimaging; PET-CT; SPECT; fMRI

Annotation

The finding:
Studies showed a reduced resting state functional connectivity within sensorimotor networks (L and R prefrontal cortex; orbitofrontal cortex; anterio-medial cingulate cortex; supplementary motor area) and cerebellar networks, which was restored with symptom resolution. Frontotemporal and frontoparietal network dysfunction was linked with affective symptoms while cerebellar and prefrontal cortex dysfunction correlated with behavioral symptoms. GABAergic agents decreased aberrant activation of the orbitofrontal cortex and of the frontal, prefrontal and parietal cortices.

Strength and weaknesses:
Strengths for this systematic review include a relatively large sample size for this population (264 patients across 16 studies), including a mix of functional imaging techniques, with general homogeneity in catatonia assessment via Bush Francis Catatonia Rating Scale and/or the Northroff Catatonia Rating Scale. Limitations include the mix of observational and randomized studies, and that 241 of 264 patients were classified as suffering from catatonia deemed due to a primary psychiatric disorder, with the remainder coming from one study on patients with NMDA receptor encephalitis.

Relevance:
These findings, at least based on brain region activity, support the current notion that catatonia is believed to manifest from dysfunction in several circuits, namely the cortico-striatal-thalamic and cortico-cerebellar circuits, as well as involvement from anterior cingulate and orbitofrontal networks. It suggests that these systems involve modulation by dopaminergic and by indirect GABAergic and glutaminergic tone. Functional imaging studies can help uncover relationships between catatonia symptom types and the underlying involved circuits and neurotransmitters, potentially offering further insight into tailored or targeted treatment options. Further studies are needed for the patient population that consultation psychiatrists encounter often, those suffering from catatonia in the general hospital due to medical illness. Further studies in this population are warranted.

PUBLICATION #2 — Catatonia

Exploring seasonality in catatonia diagnosis: Evidence from a large-scale population study.

Tomas Mastellari, Chloé Saint-Dizier, Thomas Fovet, Pierre-Alexis Geoffroy, Jonathan Rogers, Antoine Lamer, Ali Amad.

Abstract: Psychiatry Res. 2024 Jan:331:115652. doi: 10.1016/j.psychres.2023.115652. Epub 2023 Dec 1.

Catatonia is a severe psychomotor syndrome mainly associated with psychiatric disorders, such as mood disorders and schizophrenia. Seasonal patterns have been described for these psychiatric disorders, and a previous study conducted in South London showed for the first time a seasonal pattern in the onset of catatonia. In this study, we aim to extend those findings to a larger national sample of patients admitted to French metropolitan hospitals, between 2015 and 2022, and to perform subgroup analyses by the main associated psychiatric disorder. A total of 6225 patients diagnosed with catatonia were included. A seasonal pattern for catatonia diagnosis was described, using cosinor models. Two peaks of diagnoses for catatonic cases were described in March and around September-October. Depending on the associated psychiatric disorder, the seasonality of catatonia diagnosis differed. In patients suffering with mood disorders, peaks of catatonia diagnosis were found in March and July. For patients suffering with schizophrenia, no seasonal pattern was found.

Annotation

The finding:
The number of diagnoses of catatonia increased from 2015 to 2018, decreased from 2019 to 2021 and increased again in 2022. 43.6% of included patients had no psychiatric diagnosis (only a medical diagnosis) associated with the catatonia. 32.3% of included patients had co-occurring diagnoses of psychiatric and other medical conditions. 24.1% of included patients had only psychiatric diagnoses coded. Two overall diagnostic peaks were noted, in March and in September-October. Those with catatonia associated with mood disorders peaked in presentation in March and increased through a second peak in July. No peak or seasonality was stratified for catatonia amongst patients suffering from a psychotic disorder.

Strength and weaknesses:
Strengths include a substantially large sample size across multiple sites, which provides the second in a series of studies to evaluate such seasonal peaks. Limitations include the observational nature of the study and the localization to hospitals in metropolitan France. Only dates of admission were tracked, not dates of registration of the diagnosis, indicating a possible measurement bias. The study did not track meteorologic variables such as temperature, hours of sunshine, percentage of humidity or pollution data. While no peak was stratified for patients with psychotic disorders, patients with co-existing psychosis and mood disorders (i.e. affective psychosis) were excluded, thus limiting the associative findings in this population which develops catatonia.

Relevance:
This is the second study identifying similar seasonal peaks in catatonia diagnosis, centring on season changes (end of winter and beginning of spring in March; end of summer and beginning of autumn in September-October). Catatonia associated with mood disorders appears to peak at the end of the seasons when depression (winter) and mania (summer) have been found to peak. Of note, the number of diagnoses of catatonia decreased from 2019-2021, with authors suggesting a decrease in hospital utilization during the COVID pandemic.